The Medicaid expansion celebrations are premature
Published March 9, 2023
North Carolina has witnessed a spate of glowing and upbeat news reports and commentaries in recent days after Republican legislative leaders announced last week that they had reached an agreement to expand the state’s Medicaid program.
Multiple local and national outlets described the state as, after more than a decade of delay, now on the glidepath to providing access to healthcare for 600,000-plus uninsured people of modest income.
Kevin Siers – the gifted and always acerbic editorial cartoonist for the Charlotte Observer – was moved to create a downright heartwarming imagein which Senate leader Phil Berger and House Speaker Tim Moore were portrayed as winsome characters from an old “Peanuts” cartoon smiling and shaking hands over a sign that reads “the doctors are finally in.”
Meanwhile, beleaguered healthcare advocates – worn down by years of disheartening defeat and ever-cognizant of the need to avoid getting on the wrong side of powerful politicians with a demonstrated willingness to punish critics and opponents – were quick to claim a long-denied victory, while issuing statements of thanks and praise to GOP leaders.
Even Democratic Gov. Roy Cooper described the agreement as “monumental step.”
Altogether, it was enough to make a body swoon with hope and optimism that light had dawned on a weary world, and that Berger and Moore had, at long last, beaten their frequently destructive political swords into plowshares.
All that was left was to make arrangements for a kumbaya signing ceremony.
At the risk, however, of acting the part of the proverbial skunk at the picnic, it must be reported that such gleeful celebrations are almost certainly premature. While it’s understandable that so many people have looked at the Berger-Moore announcement with their hearts, a more thorough examination through unblinking eyes reveals some huge problems with the GOP agreement.
First, of course, is how the deal came about — that is, as a result of closed-door negotiations that involved only Republicans. While Cooper has expressed a measure of optimism about the announcement, the fact remains that he was not involved in the dealmaking.
And that fact has given rise to another truck-size problem – namely, the Berger-Moore caveat that they’ll only deign to go along with expansion if it takes place several months from now, and as part of a comprehensive state budget bill.
Think about what that means.
For each of the last several years, hundreds – and in many cases, thousands – of North Carolinians have suffered preventable premature death because of the failure to expand Medicaid. By delaying expansion yet again – say, for example, until a few weeks into the new fiscal year (an optimistic estimate of when a final budget deal might get done) — the GOP plan has cruelly and unnecessarily condemned hundreds more North Carolinians to a similar fate. The delay will also mean adding to the billions of dollars in federal funds the state has forgone.
And, of course, the fact that the deal is contingent on final passage of a budget highlights another huge problem: The fact that Medicaid expansion will only become law if Cooper agrees to an array of unrelated Republican priorities that will no doubt be included in the omnibus bill — or if he sees his veto overridden.
Each year, the budget bill is packed with all manner of controversial appropriations and dozens of substantive law changes unrelated to state spending. On numerous occasions in recent years, GOP leaders have packed the measure with hugely important law changes that have scarcely been discussed in public at the Legislative Building, and on which debate was effectively prohibited.
What’s to stop them from doing the same this year?
Could Medicaid expansion end up being dependent on an agreement to limit abortion rights? How about big new tax cuts for corporations and the wealthy and the further privatization and defunding of our public schools? The “don’t say ‘gay’” education bill? New redistricting maps?
Dawn Baumgartner Vaughan of Raleigh’s News & Observer reported recently that the abortion assault may be a bridge too far even for the GOP, but other issues might well not be. She notes that provisions further increasing legislative powers at the expense of the governor are considered a real possibility.
In short, Republican lawmakers are setting themselves up to use Medicaid expansion as a bargaining tool – a political cudgel with which to further entrench their own power, while further advancing a far-right policy agenda that’s increasingly out of step with the generally moderate views of most North Carolinians.
And that’s just wrong.
The bottom line: Medicaid expansion needs to happen now and without unrelated conditions. Unfortunately, the GOP plan is about playing cynical political games with the lives of vulnerable people.
And much as they might wish it weren’t the case, all North Carolinians would do well to wake up to this distinctly unpleasant truth.